Healthcare Provider Details

I. General information

NPI: 1336914464
Provider Name (Legal Business Name): PROF. CARMELLA L LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MACKLIND AVE # 115
SAINT LOUIS MO
63110-1432
US

IV. Provider business mailing address

1230 MACKLIND AVE # 115
SAINT LOUIS MO
63110-1432
US

V. Phone/Fax

Practice location:
  • Phone: 314-591-8105
  • Fax: 205-891-1684
Mailing address:
  • Phone: 314-591-8105
  • Fax: 205-891-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number142490
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: